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ImportanceNarrowband UV-B (NB–UV-B) phototherapy is used extensively to treat vitiligo. Afamelanotide, an analogue of a–melanocyte-stimulating hormone, is known to induce tanning of the skin.ObjectiveTo evaluate the efficacy and safety of combination therapy for generalized vitiligo consisting of afamelanotide implant and NB–UV-B phototherapy.Design, Setting, and ParticipantsThis study was performed in 2 academic outpatient dermatology centers and 1 private dermatology practice. We enrolled men

ImportanceAirline pilots and cabin crew are occupationally exposed to higher levels of cosmic and UV radiation than the general population, but their risk of developing melanoma is not yet established.ObjectiveTo assess the risk of melanoma in pilots and airline crew.Data SourcesPubMed (1966 to October 30, 2013), Web of Science (1898 to January 27, 2014), and Scopus (1823 to January 27, 2014).Study SelectionAll studies were included that reported a standardized incidence ratio (SIR), standardize

ImportanceIndoor tanning is widespread among young adults in the United States despite evidence establishing it as a risk factor for skin cancer. The availability of tanning salons on or near college campuses has not been formally evaluated.ObjectiveTo evaluate the availability of indoor tanning facilities on US college and university campuses (colleges) and in off-campus housing surrounding but not owned by the college. Design, Setting, and ParticipantsThis observational study sampled the top 1

ImportanceIchthyosis with confetti (IWC) is a genodermatosis caused by dominant negative mutations in the gene encoding keratin 10 (KRT10). We investigated clinical and genetic details of a substantial number of patients with IWC in order to define major and minor criteria for diagnosis of this rare disorder.ObservationsParallel clinical investigation of 6 patients with IWC revealed a novel spectrum of phenotypes. We found several features that qualify as major criteria for diagnosis, which are

ImportanceImmunosuppressed patients with solid organ transplants have an increased risk for nonmelanoma skin cancer. Vismodegib has been reported to be effective for select locally advanced or metastatic basal cell carcinomas. However, there is no data documenting the use and safety of vismodegib in immunosuppressed organ transplant patients.ObservationsWe describe a 78-year-old white man with a history of orthotopic heart transplant, immunosuppressed with low-dose cyclosporine, who presented to

ImportanceThe prognosis of advanced cutaneous T-cell lymphoma (CTCL), including Sézary syndrome and mycosis fungoides (MF), is poor. So far, no curative option apart from allogeneic stem cell transplantation is available. Large cell transformation often hallmarks cases with a more aggressive clinical course, and large tumor cells may express CD30. Recently, brentuximab vedotin, a conjugate of an anti-CD30 antibody and monomethylauristatin E, which inhibits the polymerization of microtubuli, has

ImportanceMEK inhibitors are being evaluated in clinical trials for treatment of different malignant neoplasms; trametinib dimethyl sulfoxide was approved by the US Food and Drug Administration for melanoma in 2013. We present 3 cases of patients receiving MEK inhibitors who developed an atypical eruption.ObservationsThree patients who were receiving different MEK inhibitors (selumetinib, cobimetinib, and trametinib) developed an eruption, all associated with unique duskiness. Drug hypersensitiv

ImportanceThe cause of follicular spicules in multiple myeloma (MM) is not known.ObservationsWe present a case of follicular spicules in a patient with MM, which is very reminiscent of trichodysplasia spinulosa caused by a polyomavirus. No trichodysplasia spinulosa–associated polyomavirus could be isolated from the skin lesions; however, the spicules were positive for Merkel cell carcinoma virus, which is also a polyomavirus.Conclusions and RelevanceFollicular spicules in MM are probably not cau

ImportanceNail psoriasis can be difficult to treat and has a significant effect on quality of life. Relatively few controlled trials evaluating treatments for nail psoriasis have been published. There is an unmet need for treatment recommendations to guide therapeutic decisions.ObjectiveTo develop treatment recommendations for nail psoriasis from the Medical Board of the National Psoriasis Foundation.Evidence ReviewA PubMed search for publications on nail psoriasis treatments was performed from

The effect of ?-3 fatty acid (?-3FA) supplementation on triglyceride levels was assessed in a retrospective study of patients taking isotretinoin for acne. Oral isotretinoin (13-cis-retinoic acid) is commonly used in the treatment of severe and recalcitrant acne. This treatment commonly results in complete clearance of acne with long-term remission; however, treatment is associated with a number of adverse effects, including hypertriglyceridemia. At high levels of isotretinoin, hypertriglyceride

Cutaneous adverse effects are one of the most frequent adverse events (AEs) associated with the use of BRAF inhibitors, reported in 92% to 95% of patients. Such dermatologic reactions include maculopapular eruptions, photosensitivity, verrucous keratoses, keratosis pilaris–like eruptions, keratoacanthomas, and melanocytic proliferations. Hand-foot skin reaction (HFSR) occurs in 19% to 60% of patients taking BRAF inhibitors and presents as tender, erythematous patches on the palms and soles. Pain

Cutaneous melanoma metastases can be categorized into satellite (=2 cm from primary melanoma), in-transit (>2 cm from primary melanoma but not beyond the regional nodal basin), and distant metastases (>2 cm from primary melanoma and beyond the regional nodal basin). The presence of cutaneous melanoma metastases is a component of the American Joint Committee on Cancer 2010 TNM (tumor node metastasis) staging system and is a poor prognostic criterion. Dermoscopy is a skin imaging technique using a

Multiple endocrine neoplasia type 1 (MEN-1) is an autosomal dominant syndrome consisting of endocrine tumors of the parathyroid gland, pituitary gland, and pancreas. MEN-1 is caused by loss of function mutations in the MEN1 gene, which encodes the tumor suppressor protein menin. Cutaneous collagenomas and facial angiofibromas also have been associated with MEN-1 and may serve as diagnostic clues to the diagnosis. We present a case of amelanotic melanoma resembling a large angiofibroma in a young

To the Editor In their recent article, “Scope of Physician Procedures Independently Billed by Mid-Level Providers in the Office Setting,” Coldiron and Ratnarathorn describe the expanding scope of dermatologic mid-level practitioners. Specifically, in 2012 physician assistants (PAs) and nurse practitioners (NPs) performed and billed independently for more than 4 million procedures, 54.8% of which were dermatologic.

It has long been known that physical exertion, as in long-distance running, can cause medical problems. Think of Pheidippides, a Greek soldier who died after a long run to Athens bringing news of the Athenian victory in the Battle of Marathon in 490 bc. He found the major officials waiting anxiously for news. After gasping “Joy, we win,” he died. The current marathon distance of 26 miles 385 yards is roughly the distance from Marathon to Athens.

Everyone is familiar with wrinkling of the fingertips after prolonged exposure to water. While the exact mechanisms are not known, both an intact sympathetic nervous system and osmotic effects are important. Two recent articles cast a new light onto wrinkling. In 2011, Changizi et al speculated that wrinkled fingers are water-induced rain treads allowing maximal drainage of water from digits and improving grip under wet conditions. While Haseleu et al now have shown that water-induced wrinkling

Krokodil (from the Russian ?po?o???, or “crocodile”), which became popular in Russia around 2003, is a homemade opioid injectable drug synthesized from codeine (which is available over the counter in Russia) and other easily obtained materials. Over the years, krokodil has slowly spread across Europe, and has been sensationalized in various media reports as a drug that allegedly “turns people into zombies” and “eats junkies alive.” Indeed, krokodil can leave abusers disfigured, with scaling and

Josef Jadassohn was a dermatologist who was world-renowned not only for his devoted work and numerous contributions but also for the legacy of his coworkers and followers. Born into a Jewish family on September 10, 1863, in Liegnitz, Silesia (now Poland), Jadassohn attended medical school at Göttingen, Breslau, Heidelberg, and Leipzig. During medical school, Jadassohn became fascinated by how the pathogenesis of diseases could be revealed by studying functional pathology. After medical school, h

When my father was in second grade, a fellow student dared him to walk across a wooden board that spanned a large puddle after a heavy rainstorm. To the crowd’s amusement, the board snapped when he was halfway across, submerging him in murky water. Soaking wet, embarrassed, and tearful, he had to call his mother from the principal’s office to ask for a change of clothes. So starts a story told by one of this article’s authors (E.M.M.).

Sometimes we can learn a lot even from a single word. Take, for example, the word “trench,” which means a ditch used for concealment and protection in war. One hundred years ago, that word took on a more horrifying meaning when it began to describe the most devastating form of war mankind had ever invented: the “trench warfare” of World War I.